Like many young, college-educated people, I have been an ardent supporter of universal healthcare and widespread socialism without really knowing what either of those things are. In fact, I could have gone my entire twenties unquestionably supporting my pinko-liberalism without a first-hand experience with what socialism might look like. But, as fortune would have it, I was given the opportunity to test-drive government run, tax-funded, universal healthcare two years ago. It came in the crucible of a rabies scare.

Like many young, college-educated people, I studied abroad when I was an undergraduate. But I missed my own university’s deadline, and I had to scramble to patchwork a new plan through another college. My choices, of which there would have been hundreds if I just made that deadline, distilled down to four—and it quickly became clear that only one would work at all. Paris, France required French fluency, which my five years of French studies had impressively managed not to bring to fruition. Ulm, Germany required German fluency, which despite never having even one lesson, was on par with my French talents. And Uppsala, Sweden required a steely resolve to be visited by the icy specter of death at any moment in a sparsely populated Arctic hellscape. So Copenhagen, Denmark it was.

After some hasty research, I became incredibly excited at my de facto choice. Denmark boasted liberal ideology, beautiful people, and one of my favorite talking points: universal healthcare! Little did I know how useful this last attribute would factor into my stay.

Shortly after my arrival in Denmark, I received an email recommending that I pick up my Civil Personal Registration (CPR) card, which is essentially a social security card for Danish citizens. This would allow me to access government services, open a bank account, and apply for a library pass. While my card did say “visitor” on it, I was afforded many of the rights that born and raised Danes receive. I was even assigned a doctor. I took solace knowing that if I plunged into the beautiful Pelbinge Sø after a Tuborg-soaked stumble home from the bar, the Danish government and its beautifully cheek-boned taxpayers would cover me. Fortunately, I never incurred injury in Denmark.

Malady, however, was waiting in the wings upon stepping off the plane in Sofia, Bulgaria—the land of the rabid dog.

Let me get off on the right foot with this publication’s extensive and proud Bulgarian audience: Bulgaria is a beautiful country, and the people I met there were incredibly warm. The cuisine is delicious. I definitely enjoyed my time in Bulgaria—save for about 20 seconds of it. My sister had come to visit me in Copenhagen, and we travelled east together to visit her Bulgarian then-boyfriend, Nikola, who was visiting his mother in Sofia, the capital. Having a local guide improved our experience tenfold, and having an old Bulgarian woman with a lifetime of recipes cooking dinner for us was quite an asset, especially the amazing homemade sarmice (to this publication’s extensive Bulgarian audience, you know what I’m talking about).

On the final evening of our stay, my sister and Nikola decided to go to dinner together, so I planned to spend my evening seeing a movie. We looked up the theater and it turned out it was right next to the apartment where we were staying. In fact, it should have only been a five-minute walk. But the misty Bulgarian night had other plans.

A little bit of explanation here: Sofia is teeming with stray dogs. They are everywhere. You see them walking around in subways and on sidewalks or just laying down wherever. They are integrated into the culture and benignly get along with their human counterparts—typically. But as in any dog-infested city, things don’t always go perfectly.

I set out for the theater with misplaced confidence that I knew where I was headed. After walking the wrong way for twenty minutes and asking for directions twice, I decided to head back into the dense mist whence I came. Two extroverted stray dogs had the same idea. It started out innocuously enough—they barked at me. I hadn’t yet observed that during my trip, but a barking dog is not exactly cause for concern. But then the pair started following me, and fast. The braver of the two hounds trailed me by only about a few paces, and I began to worry. I hastened my stride and yelled a few desperate go away!’s but nothing was deterring this bloodthirsty beast. Without warning, the dog lunged and grabbed my pant leg. In a moment of sheer bravery, I ran away. This sufficiently tore the dog free by fraying my pants, but I knew this defeat would simply redouble his efforts. As I ran down the dark alley, I thought of my sister having to identify my body, still with her doggy bag full of telesko vareno, how it would put a damper on her evening. But as quickly as they came, the dogs retreated back into the night. I was alone again, save a few errant barks coming from somewhere in the shrouded street. I was free. I would live.

Or so I thought—a further investigation of the wound revealed two bright red circles on the back of my ankle: blood had been drawn. It didn’t hurt, but I knew the bilious saliva of the mad dog would beset soon enough. Was it rabid? It hadn’t been foaming at the mouth, and it gave up on the hunt a little too easily for a disease-addled killer. But why would it attack at all? I decided the best course of action was to just find the theater. I didn’t want to ruin my sister’s dinner, and I definitely didn’t want to explain my dog attack to an old Bulgarian woman with no English language fluency. Upon entering the movie theater (which, as it turned out, could be seen from the apartment), I immediately headed for the bathroom and, carefully positioning my ankle underneath the foam soap dispenser, I deluged the fetid wound with heaps of aerated disinfectant. While I was pleased with this improvised first aid, I wondered if it would be enough. It was perhaps only in my head, but the bite began to feel weird. Hot, and itchy. I tried not to pay it any mind. I was worried, but things were about to get much, much worse: The only movie playing in the next half an hour was Tron Legacy 3D.

I felt faint.

The only thing less comforting than spending two hours in a dark room by yourself worrying that you have rabies is spending that same duration watching Tron Legacy 3D. Plus, I couldn’t be certain that the mangy dog wouldn’t come to finish the job. I began to panic, thinking about how my fate would be inextricably linked to Tron Legacy 3D if I succumbed to rabid fever in that theater. The movie was spent in the unlikely combination of fear and utter boredom. Against all odds, my foot remained firmly attached to my leg for the entirety of the film.

Later that evening, I soberly recounting my dog tussle tale to my sister, who, like every good older sister, worried about it. She immediately got Nikola’s mom (via Nikola) on the case, asking questions and getting answers. We of course had a flight back to Denmark the following day. Would I make it that far? As luck would have it, Nikola’s mother worked as a dental hygienist in a hospital. She was friendly with many of the doctors, and assured us (via Nikola) that we would be able to see one tomorrow. And that is exactly what we did.

After talking in Bulgarian for what seemed like forever (for some reason, “can you please hurry up with the pleasantries? I am slowly dying from a rabid dog bite” was not present in my Bulgarian phrasebook), the doctor examined my ankle. His immediate response was equal parts surprising and troubling: He laughed. Out loud. And then rattled off some Bulgarian. “A scratch,” Nikola translated for us. “It’s just a little scratch.” Now everyone was laughing. The doc splashed on some alcohol, gave me a bandage and shook my hand. I was cured! I thanked him profusely, a condemned man just a moment earlier I suddenly had the zeal of new life.

But of course I did not have health care arrangements in Bulgaria—only Denmark. Nikola and his mother conferenced outside the room and decided that we must buy him something from the hospital gift shop. This next part sounds too stereotypical and downright offensive to be true, but I can confirm it happened, even if a man who was bitten by an aggressive dog is not the most reliable narrator: We bought the doctor a bottle of vodka. The hospital gift shop was flush with alcohol choices and Nikola’s mom pointed out a brand that the doctor preferred. He was very pleased with the token of gratitude (and before this publication’s extensive Bulgarian readership accuses me of slander or malign, I want you to know that during my four days in Bulgaria, I went to Plovdiv. That’s right, Plovdiv. No Americans go to Plovdiv. So you know I know I’m telling it to you straight). Nikola’s mom explained to us that gift-giving was a big custom in Bulgaria, and that when things went well for you, you were supposed to throw a party and buy everyone else drinks and gifts, which kind of makes a lot more sense than the inverse way we do it in this country. The doctor had given me good news, and I had bought him a mini-party. It was a beautiful, boozy sentiment.

Diagnosis in hand, I was feeling pretty good about my little scratch. But upon our return to Copenhagen, my sister rightly urged me to get it checked out again by my Danish doctor. Plus, my doctor was free and I was kind of itching to give Danish care a try so I could proudly brag to all my college friends upon returning that I had tried universal healthcare and be anointed socialist King of Pennsylvania. This title seemed too good to pass up.

My assigned doctor had an office right near my apartment, so my sister and I popped in to make an appointment. I was able to be seen later that day. Dr. Jørgen Jensen, as it turned out, spoke perfect English as a result of spending some high school and college years in Texas. He examined the wound and, like his Bulgarian colleague, he was not impressed by the breadth or size of the bite. He redressed it and then consulted some literature on his desk about dog bites. He told me it was unnecessary to get rabies shots as the disease had been eradicated in Western Europe, a place Bulgaria was considered part of. He hesitated when he said that, as if he was going purely off nomenclature and not intuition when including Bulgaria in the West (this publication’s extensive and esteemed Bulgarian audience, sorry but come on you know it’s sorta true. Get the stray dog situation under control and we’ll chat).

But he reaffirmed his answer. As luck would have it, the appointment after mine had been cancelled, so Dr. Jensen had some free time. He clearly didn’t see Americans much, and he relished his time talking to us and recounting a few choice memories of his Texan youth. After about ten minutes of chatting, he abruptly stopped the conversation and said he had decided to call over to the hospital to double-check about his rabies/Bulgaria assertion. As in Bulgaria, my sister and I were left out of this Danish diagnosis. At that point, I had been in Denmark for five months and could pick out “afternoon” and “dog,” but that did little to give me any indication of what he would say when he hung up the phone. What he said was this: There had been three reports of rabies in stray dogs in Sofia over the past year. This meant I had to go further down the universal healthcare rabbit hole. My life had been spared by a sick Dane canceling her appointment in a random twist of fate. I would live.

Hvidore Hospital is not in Copenhagen proper. In fact, it’s over an hour bus ride away. In early January, Denmark has about ten minutes of daylight and snow whipping in your face incessantly, so getting to the hospital was a trial. The facade of universal healthcare was beginning to crack. Why couldn’t I have gone to a closer hospital? This is the only one with rabies treatment, I was told. I was instructed to ask for a certain doctor to attend to me upon reaching the emergency room front desk. This desk is where I was informed that I was an hour late, and he had already left for the evening. The wait would be ten hours to see the next available doctor. Universal healthcare was quickly becoming not the utopia I had imagined.

But then luck visited me once again. The doctor’s assistant was still there, and he would see me in half an hour. Sleeping in a chair turned into just sitting in one! My night was improving, which was good because my sister was leaving the very next day and I felt bad that I had dragged her on this Sisyphean ordeal. The assistant explained to me that I would have to receive six shots in all. Four in the first week and two in the second. My desire to briefly dip into universal healthcare for the socialist badge it would emblazon on my chest forever was being lengthened into a trial. However, I quickly did the arithmetic and decided being alive was worth the six, hour-long trips to this distant hospital. I was earning my socialist stripes the hard way. To pile on, the assistant then told me that he couldn’t find the rabies antidote and couldn’t recall the last time anyone in Denmark was administered one. He assured me that he would have some delivered in two days, and instructed me to not die until then. Weary, but thankful, my sister and I got back on the bus and went back to my apartment.

Over the next two weeks I returned to Hvidore to get my shots. The second one had to be in a buttcheek which led to a really bizarre experience where I was instructed to drop my pants while facing a large window that looked into a different part of the hospital. I don’t know if I should chalk that up to carelessness or a general lax Europeaness, but I definitely showed my gentials to scores of sick Danish people. The other shots were thankfully in my arm.

I left Europe alive with a story to tell of two healthcare systems—one paid in booze and the other in hour-long bus-rides to the desolate Danish countryside. Neither cost me anything (my sister had covered the vodka), and I was always treated well and with good-humor.

When I returned to America, I finally had a little substance for my socialist screeds, a bit of ethos for my undying devotion to the throne of liberalism.

@josiahg The first step would be to have an honest and serious debate about the state of our health care system and how to move forward in fixing it, but 2009-2010 showed that Americans are not ready for that yet. I do sincerely hope that the ACA is a step in the right direction, though.

@josiahg Ideally I’d create a Denmark-style system out of whole cloth. While it can be costly to move from Point A to Point B even if Point B is money-saving in the long term, it is indisputable that universal systems (of which there is a wide variety) are cheaper than our private-driven hybrid system. It is also very, very difficult to argue that those systems deliver worse care.

I think the ACA as originally proposed was a great compromise, as it included both the core of the conservative health policy platform (individual mandate + subsidies) as well as a robust public option. Though we tend to think that all European countries have a NHS-style single-payer, doctors-employed-by-the-state system, most places actually have a hybrid where employers are often responsible for some or all of health insurance for their employees, and the state picks up the tab for the poor, disabled, elderly, etc.

Unfortunately, the right couldn’t accept this compromise. I have no idea what constitutes “thoughtful” right-wing health policy today aside from “Obamacare sux” and all my attempts to find out have been futile.

@stuffisthings
I think this is where I differ from most health care reformers: I don’t have a lot of confidence that universal systems are cheaper by virtue of their universality. I think U.S.-style healthcare, if universally applied, would be even more expensive on a relative basis because, as it stands, the total cost is held down by many poor people suffering or dying rather than getting healthcare.

I’d suggest cutting costs by paying doctors less, both by changing the fee-for-service model and by expanding supply through opening more medical schools. Of course, the AMA won’t allow this. I’d also suggest policies that deny non-palliative medical care to elderly people and premature infants where long-term survival is unlikely, even over patients’ objections. One might call that death panels, I guess.

@stuffisthings
I do absolutely agree with you, though, that the basis for the right’s opposition to health care reform is largely inarticulate. I guess my point is that, even beyond that, the barrier to the reforms I see as necessary will be the political influence of doctors who will oppose cuts to their pay.

@josiahg I do often wonder if there is some magic element in the US system that makes it so inefficient and expensive, and yeah doctors will fight any cuts to pay tooth and nail. But American doctors make, what, 30% more than their European counterparts (in comparison to average income in those countries)? That alone can’t explain why our system costs twice as much and provides worse outcomes to fewer people.

Actually I just looked up the numbers: total compensation for doctors and physicians in the US is about $115 billion per year. Even if we got all doctors to agree to work for free our system still wouldn’t be price competitive with other developed countries (it would go from costing ~$2.5 trillion to ~$2.4 trillion).

@josiahg I don’t think poor people dying without treatment in the US keeps the cost down (what a horrific sentence to type), because they do end up in hospitals eventually, just unable to pay their bills. The thing that drives up your system in part is that it’s too expensive for people to access preventable care, which leads to death or disability from preventable cases. That’s partly the reason for the higher maternal and infant mortality rate, for instance; women can’t afford prenatal care. On a related note, oh my god, can America just pay for contraception; it is so much cheaper then the super high incidence of unplanned pregnancies. Making it easier for people to get cheap preventative care decreases expensive costs later on.

Your system is also expensive because you have insurance companies that incur huge administrative costs. Single payer systems are cheaper because there are way fewer administrative costs.

@stuffisthings
I’d a little unsure about those numbers. One factor that those numbers might not consider is that, often, doctors have an ownership stake in medical businesses and so order services (tests, medical equipment, etc.) from those businesses, taking profits as owners.

But I definitely agree that, to a large extent, it’s mysterious why the U.S. system costs so much and delivers so little.

@josiahg I was just drawing on what I remembered from lectures about health care administration in grad school, but there is data to support it: “In the United States, health care administration cost $294.3 billion, or $1,059 per capita. In Canada, health care administration cost $9.4 billion, or $307 per capita… A system with multiple insurers is also intrinsically costlier than a single-payer system. For insurers it means multiple duplicative claims-processing facilities and smaller insured groups, both of which increase overhead. Fragmentation also raises costs for providers who must deal with multiple insurance products.”

@josiahg Also, Canada does have similar problems re: the tyranny of doctors. I wish they would expand the scope of practice for nurses, which would cut wayyyy down on costs for everyone and improve the health care provider shortage.

One of the main reasons for the cost differences is that there is no competition for Healthcare because its an employee benefit. When was the last time someone saw a healthcare insurance commercial? But i’m sure everyone has seen automotive insurance commercials, since car insurance is bought at the consumers discretion, not their employers.

Insurance agencies aren’t the ones making the outrageous profits off the healthcare systems, hospitals and medical device providers are. Hospitals can set their prices at whatever rate they want and insurance agencies don’t fight because they can just raise their rates to cover the extra costs. Since the majority of Americans receive healthcare subsidized by employment (due to federal mandate), businesses, not consumers pay for rising medical costs.

The best way to fix this is not offering universal healthcare…yet. We need to decrease medical costs first. Removing healthcare as an employment benefit is the first step. This would increase competition among firms to lower their rates and force hospitals to practice more discretion with setting prices. Because there will be significant windfall as consumers have to pay significantly higher prices initially, there needs to be some government subsidized options to alleviate the financial pressure at least initially.

Once prices have dropped, I have no doubt Universal Healthcare would be able to keep them low. Since the cost is to the government (the insurer) they have an incentive to negotiate with Hospitals to keep prices low, and if everyone has Universal Healthcare, hospitals that aren’t covered by it would have no business. Medicare currently has some of the lowest costs due to the fact that it has such a large base of consumers who tend to be sick or dying (i.e. the hospital’s CFO’s dream clients).

@josiahg Admittedly unscientific — I just multiplied the BLS reported number of doctors and physicians by the BLS reported median income. But I’d be surprised if it’s off by more than a factor or 2 or so, and since nobody is talking about forcing doctors to work unpaid I still say doctors’ pay can’t be one of the biggest factors (though there are no doubt efficiencies to be wrung out of them).

One of the challenges of developing a universal healthcare system is switching the burden of care from specialty providers to general practitioners and community health clinics staffed by nurses and NPs. Unfortunately in the US there are not enough GPs or nurses to successfully transition, and the American Medical Association has not helped anything by lobbying for restrictions on nurse practitioners. That is one issue, another is the lack of funding for public health that makes it difficult to effectively implement preventive care measures.
The ACA is, possibly, a step in the right direction, but it will not succeed without further reforms. This process is not a one shot issue, it will take years, possibly decades, before we have improved our system.

Personally, I think that the for-profit insurance industry is worthless and we should get rid of them, or at least make sure that they are providing useful insurance plans that actually help people. But that is not to say that costs in other areas don’t need to come down, including physicians salaries. We also need to change our attitude towards health, as a country.

@josiahg I can answer this! Yes, we’d outlaw it. I’ve proposed it many, many times. (Or even just, you know, eliminate the tax breaks they get for offering it. Would at least begin the process of decoupling healthcare from employment.)

Why is this any weirder than outlawing low-premium low-payout plans, which is what the ACA did?

@deepomega
It’s a little weird, or perhaps surprising, because proponents of reducing health care costs through expanding the role of free markets in healthcare (not that I think that would work, in short because of information problems, but many people do) wouldn’t seem likely to also support a law restricting employment contract terms. But of course you’re free to pick and choose among policies without regard for a party line–indeed, I find it admirable.

Now, eliminating the tax advantage of employment compensation that comes in the form of health benefits, that’s less surprising to find coupled with a free market approach to health care. And I might agree with you on eliminating that tax advantage, at least because of its distorting effects on employment contracts.

@josiahg Yeah I’m the only one I’ve ever heard of calling for banning employer-offered benefits. I think they provide huge tax code complications and also manage to distort the employee’s knowledge of what they are worth to their employer.

@Michelle Completely concur. Nurses and physician’s assistants end up doing the bulk of the consultations (based on what I saw when a relative underwent cancer treatment). Perhaps the doctors should be handling the surgery and the research.

@stuffisthings yes good point! colloquially we do often use the terms as synonyms, but they are not, true statement. this is a fun explanation of the difference, from the harvard political review : “The difference between liberals and socialists, rather, is founded on their different answers to this question: Can the principles by which I vote differ from the principles by which I live?”

Matt Powers, for a long time I thought you were wearing a wifebeater in your photo, but then (circa your last post) I finally clicked on your profile and looked closely and realized, “Oh, ok, no he’s not. Thank God.”

I’m pretty sure your experience had you been in America would have been similar, except they would have charged you for your late appointment*, not gotten you the shots that night, and presented you with a massive bill at the end.

*to be fair a lot of doctor’s here in Canada will charge you for missing an appointment as well.